Background Little is known of the epidemiology and care needs of people with adolescent-onset psychosis.

Aims To examine prevalence and the cross-sectional disability, needs and service provision for adolescent-onset psychosis in areas of central Scotland with a total population of 1.75 million.

Method We identified and contacted 103 young people using an opt-out research design. Fifty-three participants and their carers and keyworkers were interviewed using a modified version of the Cardinal Needs Schedule.

Results The 3-year prevalence was 5.9 per 100 000 general population. Twenty-one (20%) adolescents were not in contact with mental health services; 80% of first admissions were to adult acute psychiatric wards. Those interviewed had high levels of morbidity: 29 (55%) had serious to pervasive impairment of functioning; there were relatively high levels of side-effects, negative symptoms, anxiety, occupational, friendship and family difficulties. Care provision was better for‘clinical’than for‘social’domains; 20% had five or more unmet needs; 17% had at least one intractable problem.

Conclusions This low-prevalence disorder requires an assertive multi-agency approach in the context of a national planning framework.

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